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Abstract: TH-PO967

Fixed-Dose Combination (FDC) Therapy for Prevention of Cardiovascular Diseases (CVD) in Patients With or Without CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

  • Sepanlou, Sadaf G., Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
  • Mann, Johannes F., Population Health Research Institute, Hamilton, Canada
  • Joseph, Philip George, Population Health Research Institute, Hamilton, Ontario, Canada
  • Malekzadeh, Reza, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
  • Yusuf, Salim, Population Health Research Institute, Hamilton, Ontario, Canada
Background

CKD patients carry a high CVD risk. To reduce that risk, a FDC containing at least two antihypertensive agents, statin, with or without aspirin may be effective in primary prevention.

Methods

Three randomized trials comparing FDC to control were included in an individual participant data meta-analysis (TIPS-3, HOPE-3, PolyIran), with 18,162 participants free from CVD. Main composite outcome was time to first event of CV death, myocardial infarction, stroke, or revascularization. Here, we explored differential effects of FDC on the outcome among participants with CKD (eGFR <60 ml/min/1.73m2). Median follow-up was 5 years.

Results

Baseline mean eGFR was 75.8 ml/min/1.73m2 (SD 16.8) overall and 51.6 ml/min/1.73m2 (SD 7.1) in those with CKD (N= 3315). In participants without CKD, the outcome occurred in 232 (3.1%) participants in the FDC group and in 339 (4.6%) in control group (HR 0.68; 0.57-0.81). In participants with CKD, the outcome occurred in 64 (3.9%) of participants in the FDC group and in 130 (7.9%) in control group (Fig. 1) (HR 0.48; 0.35-0.65; p-value for interaction 0.047). The number needed to treat to prevent one outcome was 67 and 25 in participants without and with CKD respectively. Results were consistent with FDC therapies that did or did not include aspirin. Across sub-groups, there was no significant decline in eGFR or substantial differences in adverse events other than dizziness.

Conclusion

Relative and absolute reductions in CVD risk with a FDC treatment strategy are larger in individuals with CKD than without CKD. The large benefits in those with CKD should prompt consideration of wider use of FDC in this population for primary prevention of CVD.

Effect of FDC on primary CV outcome in those with/without CKD

Funding

  • Government Support - Non-U.S.